Elisabeth Buddenbrook lay on her back, propped up on several pillows, and both her quivering hands – those beautiful hands with pale blue veins, which were so thin, so emaciated now – were in constant motion, hastily, impulsively stroking the quilt. Under a white nightcap, her head never stopped shifting from side to side, with the dreadful rhythm of a metronome. Her lips appeared to have collapsed inwards, and her mouth kept opening and closed as she gasped for each tormented breath; her sunken eyes strayed about in search of help, resting now and then on one of those around her with an appalling look of envy – they were up and dressed, they could breathe, life was theirs, and yet all they could do was offer one last sacrifice of love: to fix their eyes upon her and watch. The night wore on without any change in her condition.

“How long can it go on like this?” Thomas Buddenbrook asked softly and pulled Dr. Grabow to the back of the room. Dr. Langhals was just giving his patient an injection. Holding her handkerchief to her mouth, Frau  Permaneder joined them.

“Quite difficult to say, my dear Senator,” Dr. Grabow replied. “Your mother may find release in the next five minutes, or this may go on for hours yet. I cannot say. What we have here is choking catarrh, a form of edema.”

“I know,” Frau Permaneder said, nodding into her handkerchief as tears streamed down her cheeks. “It often happens with pneumonia. A kind of watery fluid has collected in the pockets of the pockets of the lungs, and if it gets very bad, you can’t breathe anymore. Yes, I know.”

His hands folded in front of him, the senator looked across to the four-poster. “She must be suffering so terribly,” he whispered.

“No!” Dr. Grabow said, just as softly, but with incredible authority, determination in every wrinkle of his long, mild face. “You are mistaken, my friend, you are mistaken. The conscious mind is very clouded. Those are primarily reflex motions that you see there. Please, believe me.”

And Thomas Replied, “I hope to God they  are!” But any child could have seen from his mother’s eyes that she was totally conscious and aware of everything.

They sat back down. Consul Kröger had arrived as well, and he sat at her bedside now with reddened eyes, bending down over his cane.

The dying woman’s movements increased. Her whole body, from her crown to the sole of her feet, was apparently overcome by terrible restlessness, by unspeakable panic and agony, by an inescapable sense of abandonment and hopelessness without end. She tossed her head and wheezed, and her eyes – her poor pleasing, lamenting, searching eyes – seemed to break under the strain, and then they would close; or they would grow so large that the little veins on the eyeball were distended and bloodshot. But oblivion would not come.

It was shortly after three in the morning – Christian stood up. “I cannot take this any longer,” he said, and, supporting himself on pieces of furniture that stood between him and the door, he limped out of the room. Both Erika Weinschenk and Mamselle Severin, apparently lulled by the monotone groans of pain, had fallen asleep in their chairs, their faces rosy with the flush of slumber.

Around four, it grew worse. They propped the old woman up and wiped the sweat from her brow. It looked as if she would stop breathing altogether, and her panic increased. “Something to help me sleep,” she managed to say. “Sleep.” But the last thing they wanted to do was give her something to make her sleep.

Suddenly, just as she had done once before, she began to answer someone or something that the others could not hear. “Yes, my dear Clara, I’m coming.”

And then the struggle began anew. Was it a struggle with death? No, she was wrestling now with life to gain death. “I want to,” she gasped, “but I can’t. Something to help me sleep. Have mercy, gentlemen, give me something so I can sleep.”

At the words “have mercy,” Frau Permaneder sobbed loudly and Thomas groaned softly, clutching his head with one hand for a moment. But the doctors knew their duty. For the sake of the family, they were required under all circumstances to preserve this life as long as possible, and a narcotic would have meant the immediate loss of all resistance, the surrender of life. Doctor’s were not placed on this earth to bring death, but to preserve life at any price. And there were certain religious and moral reasons as well – they had heard all about them at the university, although they might not be able to recall them precisely at the moment. And so, instead, they stimulated her heart with various

Five o’clock – the struggle could not get any worse than this. Sitting upright, her eyes wide open for battle, Madame Buddenbrook flailed her arms, as if grasping for support or hands that were reaching out to her, and constantly answered calls that came from all directions, which only she could hear, but which seemed to be growing ever more numerous and urgent. It was as if not only her dead husband and daughter were present now, but also her parents, her parents-in-law, and other relatives who had gone before. She called out names, and no one in the room could say precisely just which of her dead relatives she meant. “Yes,” she cried, turning first in one direction and then another. “I’m coming – soon – just a moment – but – I can’t – Gentlemen, something to help me sleep – ”

At five-thirty, there was a moment of peace. And then, quite suddenly, a shudder passed over her aged, pain-racked face – the features twitched in a rush of horrified joy, trembled with deep, fearful tenderness. In the next second, she flung her arms wide, and then – so abruptly, so instantaneously that both what she had heard and her answer seemed almost simultaneous – she cried out in the most absolute obedience, with boundless, fearful, loving submission and surrender, “Here I am!” And passed on.

They had all pulled back in shock. What had happened? Whose call was it that had caused her to follow instantly?

Someone pulled the window curtain back and blew out the candles. Meanwhile, with a gentle look on his face, Dr. Grabow closed the dead woman’s eyes.

They stood there chilled by the pale light of the autumn dawn that now filled the room. Sister Leandra covered the mirror above the dresser with a cloth.